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Hello, I'm Caroline West.
Welcome to this program Healthy Feeding, Healthy Baby:
Eat for Health - Infant Feeding Guidelines,
coming to you on the Rural Health Channel.
I'd like to acknowledge that this program
is being broadcast from the land of the
Wangal people of the Darug tribe,
traditional custodians of the land
and part of the wider Aboriginal nation commonly known as 'Eora',
and we acknowledge their Elders past and present.
Tonight, our wonderful panel
will be exploring the fascinating field
of baby and infant nutrition.
Now, a healthy start to life with optimum feeding
can make all the difference to how well our children thrive
and, of course, develop.
We'll be discussing the new NHMRC Infant Feeding Guidelines
and we'll be looking at how new evidence
is shaping our nutrition recommendations.
Now, this is not just a program for health professionals -
we'd love you all to join in the conversation
by getting in touch with us and sending through your questions.
So make a comment,
and our expert panel here will try and answer it for you.
You can reach us via phone, text, email or even Twitter.
The details are on your screen now.
So send your emails to -
Text us on -
Or phone us on -
Or tweet by using -
Now let's go to our panel,
and I'd like to introduce you first to Dr Joanna McMillan.
And she's an accredited practising dietitian
and recognised, well-known face on media,
registered nutritionist.
So, welcome, Joanna, and thanks for being here.
Dr Megan Elliott-Rudder
is a general practitioner obstetrician
from Wagga Wagga, New South Wales.
So, thank you for being here.
Monica Hogan is a lactation consultant
and midwifery educator from the ACT.
So, thank you, also.
Natasha Murray is an accredited practising dietitian
from Alice Springs - a wonderful part of the world -
in the Northern Territory.
So it's fascinating.
Perhaps I can go to you first, Joanna.
You're a dietitian.
Why is it that we need these guidelines?
Why are they so important?
Well, I think the thing is, when you're a new parent particularly,
you are bombarded by advice from all sorts of people.
So from your friends, from your parents,
from your grandparents, from your aunties,
and much of that advice might be conflicting.
So what we need to do is be able to have a sound reason
for why we have set specific guidelines.
Now, it's important to point out
these guidelines are not just plucked from thin air.
These are experts who have looked at more than 50,000 scientific papers,
and these are good-quality papers
that have looked at what give us the best health outcomes,
both for the infant and for the mother.
And that's where these guidelines have come from.
So that then allows you to make sense of the good advice
and sift it out from the bad advice that you might be getting
from all other sources.
And I think it's also important for health professionals
to be singing the same song
and know that we're all giving the best advice
- based on the best evidence. - Mm.
And we're all dealing with patients here.
And, Megan, you've actually had the wonderful joy
of delivering close to 200 babies, which is a wonderful achievement.
How are these guidelines going to be useful to you?
Well, I think they're quite valuable in informing health professionals,
when we're talking with parents, pregnant women, grandparents, dads,
talking about what's going to be important for the baby,
who's a gorgeous newborn
but has so much ahead of them in terms of development -
brain development, gut development, immune system development.
And, you know, we want our children to grow healthy and strong,
to avoid risks like obesity and infection,
and the guidelines are something that we can be well grounded with -
they're good as a reference point for health professionals.
And when I'm talking with parents, new parents,
I'm often talking to them about eating -
what they're eating, what their children are eating
and how important that is for their health.
So it's all really what you're saying about outcomes, too, isn't it -
sort of getting to that point of really improving the outcome?
Well, absolutely.
And, I mean, as Joanna said, there's a huge amount of research
behind these guidelines,
and that research looks at, 'What difference does it make?'
You know, what a child eats, is that going to make any difference?
If a child is breastfed initially when they're born
or if the child doesn't get that opportunity to be breastfed,
does it make a difference?
And what about if they're only breastfed for a short time
or six months or 12 months?
And we can see that the results do make a difference
in terms of the rates of otitis media,
childhood obesity,
childhood... even cancers,
and particularly infections such as gastroenteritis
and respiratory infections that can put them into hospital.
So all these things are quite important for child health,
and then of course giving birth
is part of a woman's reproductive process,
and so that reproductive process continues as she's breastfeeding
and that affects how her uterus responds in the next few weeks,
it affects how her *** respond over months.
And that affects her risks of breast cancer, ovarian cancer.
It also affects metabolism -
so bone metabolism's different for a woman who's breastfed.
Mm. A lot of information to get across there.
And, I guess, Monica, you're used to talking to new parents
about a lot of this information out there about breastfeeding.
In terms of the guidelines,
what sort of messages are coming through loud and clear?
Well, the big recommendation
is that breastfeeding is a very important topic in Australia
and so the recommendations are that mothers, if they can,
can breastfeed for as long as they want to,
but we would like them
to try and exclusively breastfeed for six months
and then continue on through the time that they have solids.
One of the key messages is the length of time that babies will feed
is really up to mothers,
and we know that it's beneficial to feed beyond the first year of life,
into the second year,
and for as long as the mother and baby would like to.
So they're some of the key messages
in terms of why we want to get good health outcomes
for our mothers and babies.
Another key message is the Baby Friendly Health Initiative,
and there's a big push for that throughout Australia now.
And that's one of the key recommendations
that are coming out of the guidelines.
Mm.
And, Natasha, you work in the Northern Territory.
I do.
What's some of the interesting information
that's coming back in terms of how groups in remote areas
are travelling in terms of breastfeeding?
Well, women in our Indigenous remote communities -
breastfeeding really isn't an issue.
Most women breastfeed. It's only a very small percentage who don't.
But one of our big concerns
is actually with the delayed introduction of solids.
So the new guidelines recommend at around six months of age,
but in remote communities
we are actually seeing children sometimes as old as 10, 11 months
not being introduced solids until then.
So the breastfeeding's fantastic in our communities.
That's a good-news story, isn't it?
It is - it's fabulous.
So we're working with mums and health workers
to increase their knowledge about starting solids at the right ages
so that these kids can have the best outcomes
and the best health benefits.
And isn't that interesting, though, Caroline?
'Cause that's quite a difference from some other cultures
where what I see is a lot of mums
actually trying to introduce solids much earlier than that six months
because either they feel - and quite wrongly -
feel that that's going to help their baby sleep through the night
or that it's going to have some sort of benefits developmentally
or that they feel 'Oh, but my baby's more developed,
it's more advanced,' because he or she is already having solids.
And so I think that's the other thing
that's important about these guidelines -
it's taking both of these extreme groups
and everyone at various points along that spectrum
and giving us some very clear guidelines
that says, 'No, there are no benefits,
from the evidence, that introducing earlier than six months...'
and certainly that there's real problems by the delay
until that much later time that you're seeing.
And how motivated are families
when they come to see you at this point in their life cycle?
Well, that's what I love about dealing with new parents,
is that it's a time of life that the family are highly motivated
to make changes, not just because of the new baby in the house -
I'm sure that you must see the same thing, Monica -
but that it's also a chance for the family
to start improving their...
..you know, the mums often start thinking about, 'How am I eating
and how should I be eating?'
Of course, they're also thinking about getting their body back
and recovering from the pregnancy.
But, yes, it's great to see that kind of level of motivation.
And I'm sure that we all agree
that mothers always want to do the absolute best for their babies.
- Mm. Yeah. - Absolutely.
And support and guidance
can certainly come from lots of different channels -
from your GP, a nurse, a health professional -
and that's incredibly helpful,
but I also guess that there's a lot of support
that comes from trading experiences with other mothers and parents.
So let's hear now from a group of mothers
about their breastfeeding experiences
in our short film Breastfeeding Matters.
Hello, Emily. My name's Penny.
I'm a midwife here and lactation consultant
and I've come to talk to you
and congratulate you on your baby Lincoln's birth.
Thank you.
- You've had your first breastfeed? - Yes. Yes, we've had two today.
That's good. And was that comfortable?
- Yeah. Yeah. - That's good.
It's important that the breastfeeding is important to you...
Yep.
..because it's the safest and healthiest way
for babies to feed.
I breastfed Xavier for 19 months,
and Lydia's seven-and-a-half months at the moment
and I'll probably keep breastfeeding her for about the same time -
about 19 months.
I found breastfeeding really convenient and easy.
I've been lucky - I've always had lots and lots of milk.
So I've had lots of supply.
I've never needed to worry about whether my children are hungry
or not.
It's really cheap. I don't have to pay for anything.
And I guess it's also really healthy.
I have been really lucky to have both my son and daughter...
..are both really well children - they don't seem to get sick much.
And I don't know how much breastfeeding's contributed to that
or is meant to contribute to it.
From everything that I've read and seen and learned and things,
it helps children with their development
and helps with their immune systems and all that sort of thing,
so I, with both my children, tried for as long as I could
to breastfeed, but it doesn't always go for as long as you want,
but that's alright. (Chuckles)
My two-year-old I breastfed for five months
'cause my supply dried up,
and this one is four months and I'm still feeding her
and I'll feed her for as long as I can
or as long as she wants it.
I certainly know, in my case, I breastfed my three children,
and when you've got someone who's having issues,
you can just even encourage
and I guess you can use examples from your own life.
We have a very chatty group, and so you can talk about issues,
whether it's having problems with breastfeeding
or how many feeds overnight.
And because we have quite a large group,
you can get, I guess, a range of experience.
Some people were very good breastfeeders,
some had real trouble, some ended up having to go to bottles.
But because we've got the breadth of experience, you know,
a lot of people have had the same... they've had the troubles you have,
and so you can encourage - 'This is how I got through it' -
through sharing your own stories.
We've actually got a family-owned business,
so I'm lucky enough that if I get a day teaching,
'cause I'm a PE teacher,
my husband can stay at home, so that's really handy.
And we've also got all the grandparents here,
which makes it a lot easier
just for those extra hours that you need babysitting.
But otherwise we haven't really faced any barriers at this stage.
I was quite nervous when I was going back to work
with Xavier, when he was a baby,
about how he was gonna cope with me dropping a feed
at lunchtime, 'cause I would feed him at lunchtime.
And it was amazing. He just didn't seem to notice.
So all that anxiety I had prior to going to work
was all really for nothing.
And I'm starting to think about going back to work with Lydia,
so... I guess one thing I need to decide
is whether she'll have enough nutrition
to just not have a breastfeed at lunchtime
or whether she'll need some kind of a supplement,
and I'm kind of thinking that she'll probably decide for us -
we might try a few things,
and whatever she seems happiest with, we'll use.
Breastfeeding, for me, was such a wonderful experience -
to be able to have the goods on hand at all times.
I was thankful to not even have to express.
I didn't have any issues.
And so I was always with my babies,
I was never further away from them for more than three hours,
and it was a wonderful... it was a bonding experience,
and I knew that I had the healthiness in my own body
to give them the nutrients they need,
as well as the antibodies they needed.
I was unfortunate to get a gastroenteritis virus
when I was sick with one of them
and I spoke to my midwife and she was like, 'Keep breastfeeding
because the antibodies in you while you are sick
are gonna help the baby avoid the sickness themselves.'
So I guess that's another option I've got -
to express perhaps while I'm at work,
or I could even leave at lunchtime.
I'm lucky her day care will be reasonably close to work,
so I could actually just take an extended lunch break
and go breastfeed her.
So that's another option.
I feel lucky that I've got lots of options
and I'm pretty confident that something is going to work
and it's not gonna be too hard when we get to that point in time.
- A wonderful clip, wasn't it? - It was.
Monica, what did you think watching that clip?
Well, I thought it was fabulous seeing all the mothers together,
and I loved hearing the different comments that the mothers made
about, you know, talking about ideas
and helping problem-solve together as mothers
and that is just so important to the support element
of being a new parent.
So I love that.
I love hearing the different stories that the mothers would tell.
I think that was great.
And I loved the lady's term of 'having the goods on hand'.
- I loved that! - It thought that was terrific.
And it was wonderful - she was so enthusiastic, wasn't she?
She was, yeah. It was great.
And she made a really good point
that I think can translate into the childcare arena,
is that our bodies are amazing.
They can just do amazing things when we're breastfeeding,
and we can produce antibodies to help protect our babies,
just as she described with the gastroenteritis situation,
and that's something that can be carried out to all childcare areas.
So that if mothers spend a little bit of time with their babies
in the setting that their child will be in
when they start to leave them,
if they continue breastfeeding through that time,
it will help them to pass on those antibodies to their babies,
so it's very protective in that element as well.
So, Megan, in your work,
how do you actually encourage women to continue breastfeeding?
What sort of pitch do you use, if you like?
Yeah, that's a good question.
Certainly when a woman's breastfeeding,
she's got a lot of things on her mind.
She's thinking, probably at some time, most days,
'Will I continue or won't I?'
And there can be various reasons
why women decide, no, they're not going to continue at the moment.
'Cause it's interesting, isn't it,
about 96% of babies start out breastfed, which is fantastic,
but by the time we get to six months it's hard to get exact figures -
but it seems to have dropped off to maybe 50% are breastfed
or partly breastfed.
Yeah, that's exactly right.
And so what we're seeing is that
a lot of women start off breastfeeding
but then have difficulty continuing.
And some of that can be because they don't come across people
with sufficient information.
So, you know, they might come to see a health professional
and say, 'I'm concerned, I feel that my milk's drying up'
or 'I don't have enough milk',
and that health professional may or may not say to them,
'Well, did you know you can actually adjust
how much milk you're producing?
If you can fit in an extra feed
or give the baby another feed 20 minutes after you've finished,
maybe change a ***, come back, have both sides again,
that will increase your milk production.'
So you can actually adapt what you're doing
to suit your baby's needs.
And that sort of information often isn't getting out there.
'Cause that's one of the misconceptions, isn't it,
about supply and demand
and perhaps mothers feeling as though
they're not able to meet their child's nutritional requirements
and therefore topping up with a different sort of feed?
Natasha, do you have experience in that regard,
in terms of the sorts of information that you give out to young mothers?
Yeah, so there is often that thought,
especially around the four-month mark,
that, 'Oh, you know, my baby's getting fussier,
they're feeding more often than normal,
they're starting to not sleep through the night anymore,'
so there is that thought that 'My milk is drying up'.
But exactly as Megan said,
there's the whole supply/demand thing,
and kids tend to go through a growth spurt at around that time as well,
so they do need that bit of extra nutrition,
and breastmilk supply is everything - it's the perfect food.
So it supplies everything.
Or if you're living in the hotter areas of Australia
and that happens to coincide with the wet season
or the temperatures rising,
they just need more water as well, and breastmilk can supply that too.
So I guess coming back to the dietary guidelines,
there's information in the dietary guidelines
to help address women who are concerned about their milk supply.
There's information in the dietary guidelines
to help address women who are finding that feeding's painful for them,
which is often a reason why women will stop in the early weeks.
Is that quite a barrier, Monica, in terms of *** health,
and so forth?
Certainly - if women are experiencing pain,
it can be a very big barrier
and it can make them stop much earlier
than they would really like to.
So if we, as health professionals,
have access to good-quality information,
which we hear that
the Infant Guidelines are extremely well researched,
we know that, as health professionals,
we can provide the right sort of information
to help mothers if they come in with common sorts of problems,
and pain and trauma to the nipples are a very common problem
and a reason why women will either delay
or stop feeding in the early weeks.
And there are some other factors, too, aren't there,
that perhaps promote breastfeeding from those first moments
that a baby arrives?
For example, skin on skin. Tell us about that.
Definitely. So I mentioned earlier about
the Baby Friendly Health Initiative,
and one of the key points from the Baby Friendly Health Initiative
are that babies are placed on mothers' tummies,
skin to skin, as soon as they're born.
And by doing that, we're allowing the baby
to adapt to their new environment,
which is their mother on the outside.
So they've come from the mother environment inside
and they're coming to the outside.
This skin-to-skin is extremely beneficial.
It regulates the baby's temperature, stabilises their heart rate,
so after this big journey to the outside world,
the mum, just by having her baby skin to skin on her chest,
is able to calm her baby
and make sure her baby is in just the right place
for the typical mammalian response,
which is to have a little feed once they get there.
So it's the right spot for babies to be placed,
providing all is well with the baby,
and we're getting better at doing that all across Australia.
And that's a key point from this initiative,
which is very well supported in the guidelines
to help provide the best care
for mums and babies as soon as they're born.
So that's one factor that can really make a difference.
What about the use of dummies and so forth in newborns?
What are the recommendations there?
Well, the recommendations are that when babies are breastfed
that, if possible, dummies aren't used in the first month or so,
while babies are establishing their feeding,
mums are establishing their supply.
And if they would like to use a dummy after that point,
then they can do so, particularly putting babies back to sleep,
so when their babies are on their back,
that's one of the points in the guidelines that they can use.
But, I guess too, it's worth pointing out
that not everybody needs to use a dummy and it's really about choice,
and some mothers would like to use that
and so it's not something that all babies need to have in their mouth.
It's a slippery slope, isn't it?
And there are certain things we've got to be careful about
with dummies too, don't we?
I can see you nodding your head there, Natasha.
What are some of the other things that need to be kept in mind?
One of the old wives' tales that I often hear
is dipping the dummy into honey or sugar or something sweet
to helping settle baby,
and the guidelines clearly say this isn't appropriate.
If you use a dummy, just use the dummy on its own -
don't dip it into anything extra.
Isn't there a botulism risk, too, for those under one?
Yeah, yeah. Honey is not recommended for kiddies under one
because of that -
it can cause really nasty infection in little ones.
Quite uncommon, but the possibility's there.
- So leave honey until after one. (Chuckling)
And you're looking at dental health as well.
Everything that you're doing with children in the first 12 months,
you're looking at how to do this in the most safe way possible,
so, you know, you're avoiding having sweet things on their teeth
for prolonged times -
that's why if they're having bottles,
they're not lying in bed with their bottles.
It's looking at protecting their ears
so that they're not lying back propped with a bottle -
you're sitting them up and holding them so that you're reducing risks.
Mm. Yep.
And so, I guess, in terms of baby health, mother health,
there are so many fantastic benefits to breastfeeding -
how can we actually encourage women to keep going
if they're feeling as though they're getting to that point
where something else is getting in the way?
I think what we also have to point out here
is that it doesn't always work out and we have to be...
You know, we were speaking earlier about the guilt or shame
that can be on a woman
if she can't or doesn't want to continue breastfeeding,
and I think it's important
that we do point out that, although formula feeding is not as good,
it doesn't offer some of those fantastic benefits of breastfeeding,
it's really important that women are supported
and not made to feel as if they've done the wrong thing -
because in the modern context,
I know, for me, when I was a new mum and I didn't have family around me,
it was a difficult thing to continue to breastfeed past a certain point.
You know, and so I think we do also have to support every mother
regardless of what decision she makes,
and if we can encourage and support
and make it as easy as possible to breastfeed,
then that's fabulous, that's the route we should follow.
But equally, formula feeding is nutritionally adequate.
Those formulas have come on a huge amount in the last few years
and they are offering very good nutritional support.
Are there particular guidelines around that
in terms of formula feeding,
in terms of what people need to think about,
in terms of preparation, storage and so forth?
One of the big things is choosing the right formula for your baby.
There are lots of different formulas out there.
And also how you prepare it. So making sure -
'cause there are different scoops in different tins as well -
so making sure you use the scoop
that comes with the tin that you've purchased,
not to overfill it, not to under-fill it
because then you're changing the way the formula's made,
making sure bottles are cleaned and sterilised properly,
which for some people in some community groups is difficult,
the sterilisation and the cleaning process of bottles is a problem,
which can lead to more cases of gastro and things like that.
So looking at all of those aspects as well.
And for some people, formula is quite expensive too -
so in our remote communities it can be very, very expensive.
But, as you were saying, it was interesting
that so many of the women living in remote communities
are embracing breastfeeding.
Yes. Yes, they do.
And as we said, in some parts, though,
that does lead to the delayed introduction of solids,
and that can be due to not having good food access as well.
So that's sort of the balancing act we play -
if a mother decides not to breastfeed
that she has the right access to the formula in the community as well.
It's interesting what you're saying
about the women in the remote communities all breastfeeding,
and I guess that comes down to
looking at the society around you, doesn't it?
And what sort of support there is for women
in the choices that they're making.
I think sometimes we look at it as though we're saying,
'Breast or bottle - it's the woman's choice, she makes a choice.'
But, in reality, often she can't make that choice.
And I think we need to look at ways of supporting her around that.
And, you know, sometimes it's practical things
like paid maternity leave
or looking at access to child care near her workplace,
because those might be barriers that are just too difficult for her.
And then sometimes it's whether or not
her partner gives her adequate support -
are they there for her, are they changing the ***,
are they saying,
'Honey, you're doing a great job, I'm proud of you'?
And then sometimes it's just personal factors.
I mean, for some women, as one dad put it,
'It's been quite a personal thing, her ***,
and now they're out there being kitchen utensils.'
(Laughter) - You know, so...
Kitchen utensils - that's a new one, isn't it?
But there's also that sort of...
..I guess that breastfeeding's come a long way
in terms of community acceptance,
so the majority of women will feel comfortable
breastfeeding in a variety of circumstances.
But they're still up against...
Ooh, I disagree with you on that one, Caroline.
I was just about to go into the fact, though, that...
I said many women will feel comfortable,
but there's also still a bit of a backlash
against women feeding in certain areas.
You know, there have been cases that have been in the media
about people asked to leave swimming pools
and asked to leave cafes,
and so, obviously, within the community,
there's still a mixed reception, which is...
What does everyone sort of think of where we're at with that?
Well, I think that also affects the woman's view of it.
A lot of women who have spoken to me will express the fact
that they want their bodies back or they feel uncomfortable,
and this comes back to Megan's point
about if there is peer support around a woman,
it makes it much easier for her to breastfeed.
And these kind of stories that we hear
about women being asked to leave cafes and leave swimming pools
for breastfeeding in public
do nothing to help that kind of support.
And all it does is increase a woman's anxiety
about where they're going to have to breastfeed,
about something that we keep very private
suddenly is quite open and public,
and so that makes many women feel very uncomfortable.
- And very vulnerable. - Absolutely, yes.
We have to break those sort of society rules or ideas
about what breastfeeding is and when and where it's appropriate.
I think it's quite nice
that we're able to talk about breastfeeding in public.
I mean, if you look at one of the very common sources of support
that women turn to - the Australian Breastfeeding Association -
previously they weren't allowed to call themselves 'Breastfeeding'
because you couldn't put the word 'breastfeeding' in the phone book.
(Laughter) - And that's Australia in the '60s.
That's why they were called 'nursing mothers'.
- Oh, really? That's interesting. - Yes. Yes.
So, I mean, in terms of that,
I think the women who are told to leave these places,
they need to be aware that they have the right -
legally, they're protected under Australian anti-discrimination law -
that they can feed their baby wherever they like,
and, in fact, if they feel what their baby needs
is to be fed right now,
well, you know, their prime responsibility
is to look after their baby's needs.
And for some women,
they feel quite comfortable doing that wherever they are.
Others need to know that there are restrooms,
or, you know, my sister used to use something a bit like this,
just a little shawl over her shoulder
when she was feeding her baby - not because she had to
but because she felt a bit more comfortable with that.
And you get some fabulous... There's actually one that you can get
that specifically goes around your neck
so it's not going to fall down like the muslin can,
so there are things out there, and clothing -
maternity clothing has got much better -
to make it easier to breastfeed.
So I think all of these things are incredibly helpful.
Mm. OK.
So I guess we're really in a position now to encourage women
to consider breastfeeding for as long as they can
or as long as they choose to,
but really getting to that mark of
exclusively breastfed to six months...
- That's right, yes. - ..and then beyond that.
And beyond that, feeding through the introduction of solids,
which we've talked about as being around six months,
and then beyond 12 months for as long as they want to.
nd the important thing there to bring out is, though,
that any breastfeeding is beneficial.
So, you know, a lot of women, when they introduce a bottle
or perhaps they're back at work
and they're having difficulty expressing milk
so they give some formula,
it seems this idea of 'Well, then you're on the slippery slope
- and breastfeeding's on the out...' - Oh, look, absolutely.
And even if you're still doing a small amount of breastfeeding,
it is still providing benefit to both you and your baby.
And the big reason why a lot of women will breastfeed
is not for health reasons - that's kind of a bit...
We talk about that 'cause we're health professionals,
but, for a lot of women, the reason they breastfeed
is because they like that intimacy and closeness with their baby.
You know, I mean, breastfeeding can be a pleasurable and fun thing
for mums and bubs.
Mums can feel quite a strong sense of satisfaction
for what they've achieved.
And there's nothing wrong with that in terms of being part of family fun.
And babies enjoy it too.
Although I must say that if the baby attaches to the dad,
she doesn't get much milk squirting around.
(Laughter)
And when it comes to breastfeeding,
I guess there are a lot of things that may influence
a woman's decision to continue or not,
that sort of extend beyond that,
and one of them might be regaining her pre-baby body back.
Joanna, what do women want to know when it comes to that?
Well, we're in a whole world of myths here
because, as health professionals, what we say is,
'Well, the extra fat that you laid down during pregnancy
is actually to provide the energy that you then need to breastfeed.'
And I often remind mums that, in fact, breastfeeding
takes more energy than any stage of your pregnancy.
So, in theory, you know, while you're breastfeeding,
you're using up those fat stores
and it should help you to get your weight back.
But in real life, of course,
not everybody follows that textbook example
and, in fact, some women
may find that their appetite is increased dramatically
while they're breastfeeding.
They may find that they're sitting around a lot more,
they're more sedentary,
because they're spending so much time feeding,
and they may be snacking or having drinks that contain...
So it's very easy to quickly meet those energy needs,
and you might find that it does take you a bit longer
to get your weight back than otherwise.
Yes, and as you're having the little snack,
you suddenly notice the little person next to you
is just following every mouthful.
So that's an interesting thing, isn't it?
Natasha, when to know when to introduce the solids?
We've talked about the six months as being the new guidelines.
And that is one of the signs, actually, Caroline,
is when baby is very interested in what everyone around them is eating,
and some babies actually get quite upset
when someone is eating in front of them.
So the guidelines do say around six months,
but their development is really important
in knowing exactly when the right time is for that child.
And every child is slightly different.
So if you find that bubby is reaching for food,
that bubby's following your food to the mouth
and getting upset if you are eating in front of them,
if you're finding they can sit with a little bit of support
and they have good head control...
And also the tongue reflex -
if you pop a spoon or something on the lips of a little baby
about three months old, you'll find their tongue goes out.
It's called the tongue extrusion reflex.
That's actually a reflex that drops off.
And so when that reflex has gone,
that's one sign that they're ready for solids.
And that happens at around the six-month mark as well.
So watch your baby for their developmental signs
and they'll tell you when they're ready.
And it might be at around five-and-a-half months,
it might be a little bit later than six months,
and then some kiddies actually skip the whole pureed part altogether
and go straight to finger foods.
So just watch your baby and let them lead you.
And, Megan, are there any sort of hard and fast rules, I guess,
that we've grown up... many of us,
with this era of, we should pace the introduction of solids,
and we need to introduce a food every X number of days?
What's the new thinking here?
Well, that is something that's changed
with the new dietary guidelines,
and what they're recommending now
is it doesn't really matter what you start with.
Start with something that suits you, start gradually,
use a variety of different foods,
and whatever's suiting you and your baby.
I mean, your goal is going to be
that eating is part of your social life, your family activity,
and down the track
your baby's going to be eating the same food as you off the table.
So whatever's going to suit your family culturally is fine.
You don't have to take things in different...
..you know, different things at different times.
That's very interesting about the question of allergies too,
because I guess that was part of the thinking
behind a parent's decision to delay the exposure to certain foods,
but we've actually got a statement from Professor Amanda Lee,
who helped craft the guidelines,
which is really interesting, and she says -
So perhaps it would be a worthwhile point
to cut to our next short film, because it's always interesting
to see some babies and toddlers in action with their families,
to see what's actually going on out there.
So perhaps we could now go to The Feeding Journey.
Keira has a lot of fruit during the day - bananas, apples.
She likes carrot.
She has yoghurt as well during the day
and Lucas has just started on his apple slices and things like that
and a bit of banana as well, but that's sort of all he's ready for.
With Ruby here, probably soonish -
she's quite interested in us when we eat.
She watches me put my fork to my mouth quite intently,
but... yeah, we'll just try little bits at a time.
I don't think... You know, she's not starving for it or anything.
So I think a lot of people notice
that their babies get quite hungry at four months,
or 4-6 months, and they need that extra top-up,
but she's not quite there yet,
so we'll just see how we go.
She's quite content with just being breastfed at the moment.
We introduced solids at about six months.
That was the guideline at that point in time.
But he was totally disinterested.
And so we kind of persisted in giving him snacks and food
and, well, we tried to give him food for a long time
and he really wasn't interested in food
until he was about 12 months old.
And I kind of put that down to I had a really good milk supply
and I think that he was never really hungry
for anything much more.
So it was hard not to be worried about that
and hard just to know that he was growing well
when all these other babies around you are eating solids,
but in his own time he started to eat
and, you know, of course you're not gonna have a ten-year-old
that's not eating.
To be able to eat with Barry,
I do have to think about what he wants to eat,
so I tend to maybe chop the vegetables a little bit finer
and cook it into the meals
and try to make it into something like corn fritters,
something that's easy for him to pick up and eat by himself
rather than me feeding him,
and then we sit down and eat.
So I tend to shop the basic things,
for example, like carb - rice, potatoes, noodles.
We do have a lot of Asian dishes in the house because of my background
and it's simple and easy to prepare too.
Also, I always makes sure in the fridge there's root vegetables
and green vegetables.
We don't tend to eat too much red meat.
It's a personal choice and it's easier to digest fish and chicken -
that's what we find.
- You love corn, don't you? - Yummy.
In his bag, I always prepare a few things.
One is like a yoghurt bar with grains.
And he always likes that.
Sultanas, some fruit,
and the one thing is popcorn -
popcorn only cooked in vegetable oils, not butter.
Some homemade biscuits.
It's always good.
- Wow. - Wow.
More mushroom. Beautiful vegetable.
Fantastic, wasn't it, seeing a family eating together?
- It was. - Yeah, terrific.
Yeah, and Mum cooking.
We were silently discussing a few little points there
in terms of the nutritional factors that she maybe got wrong there.
But the positives were - she was making food from scratch,
it was a home-cooked meal,
the family were all eating the same thing,
they were sat around the table with the little one in a highchair,
and I think those were the real positives to bring out there.
The thing that was annoying me there was - I do want to clear up -
that red meat is not more difficult to digest than chicken and fish.
So I think that's important to point out.
In fact, red meat's really important because iron is required.
From about six months of age,
the other reason for introducing solids at that time
is that your breastmilk actually doesn't contain enough iron.
Once they hit six months,
they really need to get a dietary source other than breastmilk.
So red meat, actually, is fantastic to give to babies at that age.
Mm-hmm.
And what about the safety aspects of meal preparation
in terms of what size food should we be giving small children?
So for children the little one's age in the film clip -
he was about two - so we want to think about choking risks,
in particular, because even kids in highchairs,
they can get a bit bouncy and get a bit excited,
so if you think about how big their little windpipes are,
you don't want anything that's going to potentially block that
if they're not chewing it properly.
So, things like popcorn and frankfurters with skins on them.
Now, grapes are a great convenience food,
so a great way to get around it - chop them in half or into quarters.
- And the same with baby tomatoes. - And the same with baby tomatoes.
Yep, chop them in half or into quarters.
Anything hard - like, really supervise kids with apples
and sometimes some of the hard pears as well.
So make sure they're cut into thin slices as well.
Or even... vegetables are fantastic.
Just blanch them, chuck them in the microwave for a few seconds,
or blanch them on the stove in the steamer,
so they're soft and they're not gonna cause that potential hazard
for the littlies and maybe cause choking.
- Like a carrot, for example. - Yeah.
- Make sure it's a little softer. - Just a little bit softer.
And I think that point about supervision is important too,
especially if you've got other kids.
I think if there's older children around too,
sometimes there's popcorn around for the older kids,
and that's when it can get a little tricky for families.
So, you know, I think it's worth pointing out,
when you've got your first baby, you're a bit more diligent,
standing over them.
When you've got older toddlers
or other kids you're trying to deal with too,
it's very easy for no-one to be supervising the baby.
The little kids want to eat the same thing as the older kids,
the older kids want to share their food with the little kids,
so, yeah, keeping an eye on the kiddies
and encouraging kids to sit down to eat.
It can be really tempting to say, 'OK, just run off and play
and take this with you.'
But if you can, get them to sit down,
whether they have their own little chair
or whether you strap them into a highchair
or whether they just sit down where they are on the ground.
Keeps them safe.
Yes, and if you have any questions out there,
don't forget to contact us.
Now, we've actually had a question through.
It was from Dot.
And Dot wanted to know, why is it -
Megan, you might be able to answer this one -
why is it that some paediatricians recommend
that children start solid at four months?
That's a little confusing, isn't it?
Well, it is very confusing.
And I've certainly heard this story before.
What we're finding is, like anybody else,
we want to know what's new, we want to know the latest news.
And, certainly, timing of introduction of solids
with respect to allergies is a hot topic at the moment.
It's being discussed at paediatrician conferences,
there are papers coming out about it.
But this is the point where we have to point out
there's a difference between a theory
and something that's actually been established under the evidence.
So there are some ideas,
but the evidence, as you said, is not supporting the change yet.
And, in fact, a lot of people are guided by risks of allergies
according to the Australian Society of Clinical Immunology and Allergy,
and what they say is slightly different from the guidelines.
They say 4-6 months.
But what I say to mums is,
'See? Even the allergists are saying six months is OK.'
It's within their bracket.
So I think around six months is quite safe.
We've got the evidence to support that at the moment.
OK. So now we're at that wonderful stage of life
where we've got our six-month-old baby
who's been tracking all of your food choices
and watching what you're eating,
and so now it's time to get creative and have a bit of fun
with introducing foods for our toddlers,
so perhaps, Joanna, could you take us through some of the foods
that are your favourites for babies and toddlers?
We've brought along a few things with us today.
Obviously not everything was suitable to bring along,
so I want to just put the overarching umbrella, if you like,
it's the same as what it is for adults.
In other words, eat wholesome, natural, minimally processed foods.
You know, if I've got a bugbear in this area,
it's that in the supermarket now
there's a whole section dedicated to baby and children food and nutrition
and special foods and everything
and special packets with characters, and so on.
And it's worth pointing out that there is actually no need
for any of those foods, including the baby rice cereal.
You know, if you think back to what did we 100 or more years ago,
before any of these things were available,
well, babies simply learned to eat what their parents were eating.
Certainly we know that you shouldn't add salt to the food.
There's no need to add extra sugar. You don't want to get your...
Children already have an innate likeness for sweetness.
We don't need to encourage that any further, do we?
- Exactly. - Or they could have the whole fruit.
So include natural sugars, so we've got some lovely fruit here.
So things like strawberries and little tangerines there,
bananas and apples, and so on, are all really great foods.
And then of course vegies.
As Natasha was pointing out earlier,
do blanch the carrots so that they're a bit softer.
You know, little cubes of cheese.
A lot of kids will want to start picking foods up
and putting them into their mouths themselves.
I've brought along some quinoa
because this was one of my favourites,
and if you haven't heard of quinoa before,
this is actually a pseudo grain,
so it's closer to a seed in terms of its nutrition,
but it cooks up like a grain.
And what's interesting about quinoa
was when I was first weaning my eldest son,
I wanted a grain that was soft but gave it some texture -
he was moving on from that puree stage -
and discovered quinoa was absolutely perfect and my kids loved it,
and then we started eating more of it as a family.
So this is a really great option.
You can look beyond just your standard pasta and rice
to looking at grains like this
that are great for the whole family to consume.
Having lots of these little containers
is great to get out and about
so that you can pack some little snacks
and have some fruit in this.
And of course remember the iron thing.
So we don't have any meat here, but including meat and fish
and just either pureeing or mashing,
putting it to the right consistency
as the child moves from 6 to 12 months.
So, really, by 12 months,
they should be eating the family food, the family meals.
And joining in together.
And, I guess, you've got banana over here and you've got some yoghurt.
So we've got to also focus on some inclusions with dairy
so we've got the cheese, some yoghurt.
Banana is the perfect convenience food.
Well, it gets mashed in everybody's hair and...
- It's awesome. (Laughter)
There's always an old banana, isn't there,
in every mother's handbag?
- There is, there is. - Speaking of my own handbag here.
I can understand completely.
So you can either take the whole banana in your handbag
or chuck it into the backpack or wherever you go.
If kids... they might need a bit of help peeling it,
but they can eat it themselves, you can cut it into chunks.
The great thing is, with a fork, you can mash it up to a consistency,
so if you've got a bub who is moving on from their puree stage,
you can make it a bit lumpy, you can actually make it a bit smoother.
So you don't actually need to have a blender all the time.
And then the great thing about yoghurt
is you don't need to have special kids' yoghurts -
you can just use a plain yoghurt and just mix it in.
So just a plain yoghurt, mix in a little bit of fruit,
it can be banana, it can be strawberries,
whatever you've got on hand.
And you've got the bit of fruit, you've got the dairy as well,
which is really important for bones and teeth and for protein too.
Now, look, judging by the guidelines, a lot of our children
are doing reasonably well with fruit and vegetables,
compared to adults, that is.
But there's often still room for improvement
in terms of the consumption of vegetables,
and certainly our next question reflects
how we encourage our kids to eat more, and this is from a viewer,
and they're wanting your thoughts on using tomato sauces on foods
to help children eat their vegetables.
Over to you, the panel. Monica, do you have a thought on this?
Well, I think it's always very difficult, obviously,
if they're watching other people in the family
putting tomato sauce on their food.
So I think probably the best way to tackle that
is to use that as a 'sometimes' food.
So it's not something you would want to be adding to every meal
or to vegetables every day.
If you could possibly avoid it, I think that would be the best option.
If you do choose to use tomato sauce,
there are lots of different options out there.
So, as Monica said, use it as a 'sometimes' food.
Trial your salt-reduced varieties
because tomato sauce is quite high in salt and sugar
and just use a little amount when you do use it, as well.
We're not saying you can't use it at all.
But if you do choose to use it, just use a little amount.
But the best way to get kids to eat their vegies
is to keep offering the vegies
and keep offering them in a variety of ways.
Kids are naturally scared of new foods.
So it harks back to our caveman days...
- So we don't give up. - No, no.
'Cause people often say, 'Oh, my child doesn't eat that.'
Kids will sometimes have their own likes and dislikes.
My youngest cannot stand capsicum.
She will pull it out of anything.
And I've given it to her heaps of times.
But kids will need to see a new food up to 20 times before they'll try it
and they'll actually need to try that food
sometimes up to a dozen times before they'll actually accept it.
And that might just be smelling the food,
having it on the plate in front of them,
and one of the best things is seeing Mum and Dad or their carers,
bigger brothers and sisters, other kids, eating it.
'Peer pressure' in a positive way
is really good for getting kids to eat their vegetables.
I guess, though, that often you'll see tomato sauce,
not in the context of a vegetable,
but in the context of pastries, pies what are your thoughts
on those sorts of foods for kids?
I think Joanna was about to say something on that.
Well, the only thing I was about to say
was about putting the tomato sauce on the vegetables.
I kind of think that's a little bit sad
because then we're just training our kids to like...
..you know, it's an overwhelming flavour,
instead of allowing them to develop...
Very young kids will eat vegetables.
It's usually later you have a bit of a problem.
And we have to bear in mind that young kids' tastebuds
are very alert.
You know, they do taste slightly differently,
so the bitterness of broccoli, for example,
will taste far more bitter to a very young child
than it will to us as adults.
So I think we need to bear those things in mind.
So sometimes, you know, mashing the broccoli up with carrot.
The sweetness of the carrot will actually
give it an overall acceptance of flavours
and your very young children will taste
all those nuances of flavours between different vegetables.
If you smother the whole thing in tomato sauce,
you're really not allowing them to develop that flavour palate.
When it comes to those other foods,
like the sausages and the pies and so on,
these are also 'sometimes' foods.
Of course you can get... sausages are a great example
where you can get some very good nutritious sausages
and you can get some very awful, dreadful kind of sausages
that really are 'sometimes' foods.
So, you know, certainly trying to encourage people
to have more of the better quality ones
and limiting things like pies and so on
that are going to go with a lot of tomato sauce.
You know, a lot of parents aren't aware
quite how much fat is in pies, as well.
And so it's something that you probably wouldn't be using -
pies and pastry - every day with your child.
It might be just occasionally.
But, you know, it's like when your child's invited to a birthday party.
There's junk food there, but it's a birthday party.
You know, it's not something they're going to go to every day
or even every fortnight.
And we've talked a bit about the solid side of things.
What about the drinks?
We've got some beautiful examples of sippy cups.
What should we be doing about fluids?
You talked before, Megan, about water.
Yeah, so in terms of the cups,
what you'll find is a child can use one of these cups
probably from 6-9 months.
You can get rid of bottles and just use these.
In fact, some kids, particularly breastfed children,
will find that they don't like a bottle
and they'll just go directly on to a cup for other fluids.
So of course they can go to the plain cups,
but the parent looks at this one and goes,
'Uh, yeah, they're gonna make a huge mess.'
They're gonna definitely make a mess with that one.
That is inviting disaster, that cup.
That's why we have bibs and that's why we have mops.
(Laughter)
So these ones are really quite popular with kids
because they like the handle.
And they're quite good for parents as well
because the lid covers the spout and you don't get so much spill,
which is quite good.
And I've just brought along a bottle of water
to remind me that we have to think about the mum's needs as well.
'Cause you get so thirsty, don't you, as a young mother?
Well, you do.
And, I mean, the reflex that drives the milk to flow,
which is oxytocin, also drives your thirst.
So you don't have to drink extra
but it's nice when you're out and about and you're thirsty
to have something handy that you can drink,
so, you know, you gotta look after yourself and your own needs as well.
And I guess so often you see kids
wandering around with juices or juice packs. I mean...
Yeah, now, that's a good point.
And I must confess that I had one of my children
with a little pop-top bottle with green cordial in it
and I was at the dentist
and the dentist just looked at the child and said,
'Do you want me to throw that out for you?'
(Laughter) - Which kind of made the point to me.
And the dietary guidelines point out
that for children under the age of 12 months,
the only fluid they need is water.
Which is interesting 'cause a lot of parents feel
they're doing the right thing by giving them juice.
Or they dilute it, thinking that somehow diluted it will be OK.
But once again, you're dealing with the acidity and the erosion on teeth.
- And the sugar. NATASHA: And the high sugar content.
And so dentists despair
because so many of our children by the age of five
have erosion on their teeth or a hole in their teeth.
JOANNA: Decay. - Yes, decay.
I'll often say to parents, 'I understand that you're downtown
and you're worried the kid won't have enough to drink,'
and we seem to actually focus a little too much
on having water all the time, everywhere,
but, you know, if the child is thirsty, they will drink water.
So they're not going to dehydrate.
And what about the whole area of organic foods
'cause a lot of parents are very concerned
about the nutrition they provide their kids,
they want to know, should they be going for organic?
Well, it's really a personal choice.
There's no strong evidence, no strong research
to show that organic foods are any better nutritionally
than your standard supermarket foods either.
So if you do want to give your children organic foods
for other reasons, by all means, it's a personal choice.
But nutrition-wise, your standard apples and vegetables
and everything else in the supermarket
will give you the same value as your organic ones.
I think the decision to go organic really is...
I call it the health ladder, and it's sort of at that top tier.
We have to face facts that organic food is more expensive.
It would be lovely to be able to give everybody organic food,
but the bottom line is most Australian families
are not going to be able to afford.
And I would far rather make sure that Australian families
are meeting the guidelines for fruit and vegetable intake
before they start worrying about, 'Should it be organic?'
The choice to go organic, where there is evidence,
is about pesticides.
Where there's not strong evidence
is, you know... we have very strict testing
about the levels of pesticides that can be in our foods,
so it's important to point out that we have a very safe food supply
here in Australia,
and it is that personal choice,
whether you want to go to the organics.
On that topic, I think it's worth bringing up,
you know, 'cause we've got a lot of plastic here
and everything that's made for young children
of course is the convenience of plastic so that they can't break
and it's safe - that we're not dropping glass on the floor -
but a lot of parents are concerned
about the leaching of chemicals from plastics.
So, again, in Australia, we're quite lucky
that most of the manufacturers of these products
are fairly on the ball and they have moved with making sure
that most of these products are BPA-free,
and that's one of the chemicals that we know can leach from plastics.
So baby bottles... most of the baby bottle companies
have voluntarily taken BPA out and aren't using BPA plastic.
So there's a lot of very positive things
that manufacturers are doing here in this country.
So there's so much information, isn't there, to cover?
We could certainly cover a lot more ground.
But for those of you who are out there
who'd like some more information,
there are a number of terrific organisations
who have a range of useful information
and support on this topic.
You could go to eatforhealth.gov.au.
You could also go to the pregnancy helpline.
You could go to Pregnancy, Birth and Baby
on the 1800 882 436.
There's also the National Breastfeeding Helpline
for any parents or carers that would like more information -
1800 686 268.
So some terrific resources out there.
We're almost out of time
but what I'd like to do is just get your parting comments,
so perhaps your take-home messages.
Megan, what would you like to leave us with?
I think I'd like to leave us
with the thought that mothers are really working very hard
in difficult circumstances
and they need all the support they can get
and it will be ideal
if they get good information from their health professionals
and good support from those people who are close around them,
because, really, confidence in parenting is so important.
Yep. Natasha?
Be guided by your baby.
So at around six months, be watching for those signs,
let your baby tell you when they're ready to start solids
and when they're ready to move through the stages
from going to puree to lumpier to your finger foods
and keep in mind some kids will skip some of those stages.
- It's perfectly normal. - Yes, they will.
They've got a mind of their own, those little people, haven't they?
Jo, what would you like to leave us with?
I think my take-home message is just very simple -
stick to wholesome, natural foods
and then if you follow the family's healthy eating,
forget about thinking about fancy, bought baby and toddler foods,
then you're going to be along the right lines
and set that child up for life.
Be adventurous, allow them to try all sorts of different foods.
Fantastic. Monica?
My take-home message is a follow-on from Megan's,
that really our women and babies
need every bit of support that they can get.
So, as health professionals, look at the guidelines
and follow the information that's in them
because it will guide you to give the best advice and support.
Thank you. So thank you, all, for being with us tonight.
Fantastic. We really appreciate it.
And I hope you've found this program on the Infant Feeding Guidelines
informative and useful.
If you're interested in obtaining more information
about the issues we've raised in the program
or you'd like to watch this program again,
please visit the Rural Health Education Foundation website
at rhef.com.au
and click on the program page
Healthy Feeding, Healthy Baby: Eat For Health -
Infant Feeding Guidelines.
If you're a health professional,
don't forget to complete your CPD evaluation -
very important, that form - which can be completed online.
You will receive a certificate of participation
and, if eligible, your CPD points.
Our thanks go to the Department of Health and Ageing
for making this program possible.
And a special thanks to you for taking the time to watch
and for contributing to our discussion today.
We'd really appreciate your feedback on the program,
and your comments are incredibly important to us,
so let us know that you watched the program by sending us an email
or a text and feel free to share your views - we'd love to hear them.
I'm Caroline West. Goodbye, and join us
again on the Rural Health Channel.
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